|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$71.87
|
|
|
Service Code
|
NDC 41616093240
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Aetna Medicare |
$35.94
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: ASR Commercial |
$69.71
|
| Rate for Payer: BCBS Complete |
$28.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.85
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: Nomi Health Commercial |
$58.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.97
|
| Rate for Payer: Priority Health Narrow Network |
$50.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
VECURONIUM BROMIDE 20 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.87
|
|
|
Service Code
|
NDC 41616093240
|
| Hospital Charge Code |
11635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: ASR Commercial |
$69.71
|
| Rate for Payer: BCBS Trust/PPO |
$58.57
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: Nomi Health Commercial |
$58.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
OP
|
$71.87
|
|
|
Service Code
|
NDC 41616093240
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.75 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: Aetna Medicare |
$35.94
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: ASR Commercial |
$69.71
|
| Rate for Payer: BCBS Complete |
$28.75
|
| Rate for Payer: BCBS Trust/PPO |
$58.85
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: Nomi Health Commercial |
$58.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.97
|
| Rate for Payer: Priority Health Narrow Network |
$50.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
VECURONIUM BROMIDE 20 MG IV SOLUTION FOR DRIP
|
Facility
|
IP
|
$71.87
|
|
|
Service Code
|
NDC 41616093240
|
| Hospital Charge Code |
500307
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$71.87 |
| Rate for Payer: Aetna Commercial |
$64.68
|
| Rate for Payer: ASR ASR |
$69.71
|
| Rate for Payer: ASR Commercial |
$69.71
|
| Rate for Payer: BCBS Trust/PPO |
$58.57
|
| Rate for Payer: BCN Commercial |
$55.72
|
| Rate for Payer: Cash Price |
$57.49
|
| Rate for Payer: Cofinity Commercial |
$67.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.50
|
| Rate for Payer: Healthscope Commercial |
$71.87
|
| Rate for Payer: Healthscope Whirlpool |
$69.71
|
| Rate for Payer: Mclaren Commercial |
$64.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.09
|
| Rate for Payer: Nomi Health Commercial |
$58.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.25
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$24,335.77 |
| Rate for Payer: Aetna Commercial |
$21,902.19
|
| Rate for Payer: Aetna Medicare |
$21.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.64
|
| Rate for Payer: ASR ASR |
$23,605.70
|
| Rate for Payer: ASR Commercial |
$23,605.70
|
| Rate for Payer: BCBS Complete |
$11.99
|
| Rate for Payer: BCBS MAPPO |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$19,928.56
|
| Rate for Payer: BCN Commercial |
$18,867.52
|
| Rate for Payer: BCN Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$19,468.61
|
| Rate for Payer: Cash Price |
$19,468.61
|
| Rate for Payer: Cofinity Commercial |
$22,875.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$24,335.77
|
| Rate for Payer: Healthscope Whirlpool |
$23,605.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$21.31
|
| Rate for Payer: Mclaren Commercial |
$21,902.19
|
| Rate for Payer: Mclaren Medicaid |
$11.42
|
| Rate for Payer: Mclaren Medicare |
$21.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.38
|
| Rate for Payer: Meridian Medicaid |
$11.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: Nomi Health Commercial |
$19,955.33
|
| Rate for Payer: PACE Medicare |
$20.24
|
| Rate for Payer: PACE SWMI |
$21.31
|
| Rate for Payer: PHP Commercial |
$23.44
|
| Rate for Payer: PHP Medicaid |
$11.42
|
| Rate for Payer: PHP Medicare Advantage |
$21.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,323.00
|
| Rate for Payer: Priority Health Medicare |
$21.31
|
| Rate for Payer: Priority Health Narrow Network |
$17,059.37
|
| Rate for Payer: Railroad Medicare Medicare |
$21.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,415.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.31
|
| Rate for Payer: UHC Exchange |
$33.03
|
| Rate for Payer: UHC Medicare Advantage |
$21.31
|
| Rate for Payer: UHCCP DNSP |
$21.31
|
| Rate for Payer: UHCCP Medicaid |
$11.42
|
| Rate for Payer: VA VA |
$21.31
|
|
|
VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,335.77
|
|
|
Service Code
|
HCPCS J3380
|
| Hospital Charge Code |
170876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15,818.25 |
| Max. Negotiated Rate |
$24,335.77 |
| Rate for Payer: Aetna Commercial |
$21,902.19
|
| Rate for Payer: ASR ASR |
$23,605.70
|
| Rate for Payer: ASR Commercial |
$23,605.70
|
| Rate for Payer: BCBS Trust/PPO |
$19,831.22
|
| Rate for Payer: BCN Commercial |
$18,867.52
|
| Rate for Payer: Cash Price |
$19,468.61
|
| Rate for Payer: Cofinity Commercial |
$22,875.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,468.62
|
| Rate for Payer: Healthscope Commercial |
$24,335.77
|
| Rate for Payer: Healthscope Whirlpool |
$23,605.70
|
| Rate for Payer: Mclaren Commercial |
$21,902.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,685.40
|
| Rate for Payer: Nomi Health Commercial |
$19,955.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15,818.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21,415.48
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.42 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$264.19
|
| Rate for Payer: Aetna Medicare |
$146.78
|
| Rate for Payer: ASR ASR |
$284.74
|
| Rate for Payer: ASR Commercial |
$284.74
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: BCBS Trust/PPO |
$240.39
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$275.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$293.55
|
| Rate for Payer: Healthscope Whirlpool |
$284.74
|
| Rate for Payer: Mclaren Commercial |
$264.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Nomi Health Commercial |
$240.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.21
|
| Rate for Payer: Priority Health Narrow Network |
$205.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.32
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: ASR Commercial |
$4.11
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$293.55
|
|
|
Service Code
|
NDC 68382001901
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.81 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$264.19
|
| Rate for Payer: ASR ASR |
$284.74
|
| Rate for Payer: ASR Commercial |
$284.74
|
| Rate for Payer: BCBS Trust/PPO |
$239.21
|
| Rate for Payer: BCN Commercial |
$227.59
|
| Rate for Payer: Cash Price |
$234.84
|
| Rate for Payer: Cofinity Commercial |
$275.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$234.84
|
| Rate for Payer: Healthscope Commercial |
$293.55
|
| Rate for Payer: Healthscope Whirlpool |
$284.74
|
| Rate for Payer: Mclaren Commercial |
$264.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.52
|
| Rate for Payer: Nomi Health Commercial |
$240.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.32
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.48 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna Commercial |
$381.33
|
| Rate for Payer: Aetna Medicare |
$211.85
|
| Rate for Payer: ASR ASR |
$410.99
|
| Rate for Payer: ASR Commercial |
$410.99
|
| Rate for Payer: BCBS Complete |
$169.48
|
| Rate for Payer: BCBS Trust/PPO |
$346.97
|
| Rate for Payer: BCN Commercial |
$328.49
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$398.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$423.70
|
| Rate for Payer: Healthscope Whirlpool |
$410.99
|
| Rate for Payer: Mclaren Commercial |
$381.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.25
|
| Rate for Payer: Priority Health Narrow Network |
$297.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.86
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$4.24
|
|
|
Service Code
|
NDC 68084084411
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.24 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.11
|
| Rate for Payer: ASR Commercial |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: Cash Price |
$3.39
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.73
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$423.70
|
|
|
Service Code
|
NDC 68084084401
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.40 |
| Max. Negotiated Rate |
$423.70 |
| Rate for Payer: Aetna Commercial |
$381.33
|
| Rate for Payer: ASR ASR |
$410.99
|
| Rate for Payer: ASR Commercial |
$410.99
|
| Rate for Payer: BCBS Trust/PPO |
$345.27
|
| Rate for Payer: BCN Commercial |
$328.49
|
| Rate for Payer: Cash Price |
$338.96
|
| Rate for Payer: Cofinity Commercial |
$398.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.96
|
| Rate for Payer: Healthscope Commercial |
$423.70
|
| Rate for Payer: Healthscope Whirlpool |
$410.99
|
| Rate for Payer: Mclaren Commercial |
$381.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.14
|
| Rate for Payer: Nomi Health Commercial |
$347.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.86
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$264.96
|
|
|
Service Code
|
NDC 51079048020
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.98 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$238.46
|
| Rate for Payer: Aetna Medicare |
$132.48
|
| Rate for Payer: ASR ASR |
$257.01
|
| Rate for Payer: ASR Commercial |
$257.01
|
| Rate for Payer: BCBS Complete |
$105.98
|
| Rate for Payer: BCBS Trust/PPO |
$216.98
|
| Rate for Payer: BCN Commercial |
$205.42
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$249.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$264.96
|
| Rate for Payer: Healthscope Whirlpool |
$257.01
|
| Rate for Payer: Mclaren Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.22
|
| Rate for Payer: Nomi Health Commercial |
$217.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.16
|
| Rate for Payer: Priority Health Narrow Network |
$185.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.16
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
IP
|
$264.96
|
|
|
Service Code
|
NDC 51079048020
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.22 |
| Max. Negotiated Rate |
$264.96 |
| Rate for Payer: Aetna Commercial |
$238.46
|
| Rate for Payer: ASR ASR |
$257.01
|
| Rate for Payer: ASR Commercial |
$257.01
|
| Rate for Payer: BCBS Trust/PPO |
$215.92
|
| Rate for Payer: BCN Commercial |
$205.42
|
| Rate for Payer: Cash Price |
$211.97
|
| Rate for Payer: Cofinity Commercial |
$249.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.97
|
| Rate for Payer: Healthscope Commercial |
$264.96
|
| Rate for Payer: Healthscope Whirlpool |
$257.01
|
| Rate for Payer: Mclaren Commercial |
$238.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.22
|
| Rate for Payer: Nomi Health Commercial |
$217.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$233.16
|
|
|
VENLAFAXINE 37.5 MG TABLET
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
NDC 51079048001
|
| Hospital Charge Code |
12207
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: ASR ASR |
$2.57
|
| Rate for Payer: ASR Commercial |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.12
|
| Rate for Payer: Healthscope Commercial |
$2.65
|
| Rate for Payer: Healthscope Whirlpool |
$2.57
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.25
|
| Rate for Payer: Nomi Health Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.32
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.33
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.43 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: ASR ASR |
$285.67
|
| Rate for Payer: ASR Commercial |
$285.67
|
| Rate for Payer: BCBS Trust/PPO |
$239.99
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.67
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.16 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: ASR Commercial |
$303.17
|
| Rate for Payer: BCBS Trust/PPO |
$254.70
|
| Rate for Payer: BCN Commercial |
$242.32
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$312.55
|
| Rate for Payer: Healthscope Whirlpool |
$303.17
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$268.60
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.44 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$241.74
|
| Rate for Payer: Aetna Medicare |
$134.30
|
| Rate for Payer: ASR ASR |
$260.54
|
| Rate for Payer: ASR Commercial |
$260.54
|
| Rate for Payer: BCBS Complete |
$107.44
|
| Rate for Payer: BCBS Trust/PPO |
$219.96
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: Cash Price |
$214.88
|
| Rate for Payer: Cofinity Commercial |
$252.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.88
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Healthscope Whirlpool |
$260.54
|
| Rate for Payer: Mclaren Commercial |
$241.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.31
|
| Rate for Payer: Nomi Health Commercial |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.35
|
| Rate for Payer: Priority Health Narrow Network |
$188.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.37
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$268.60
|
|
|
Service Code
|
NDC 65862052790
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.59 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Aetna Commercial |
$241.74
|
| Rate for Payer: ASR ASR |
$260.54
|
| Rate for Payer: ASR Commercial |
$260.54
|
| Rate for Payer: BCBS Trust/PPO |
$218.88
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: Cash Price |
$214.88
|
| Rate for Payer: Cofinity Commercial |
$252.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.88
|
| Rate for Payer: Healthscope Commercial |
$268.60
|
| Rate for Payer: Healthscope Whirlpool |
$260.54
|
| Rate for Payer: Mclaren Commercial |
$241.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.31
|
| Rate for Payer: Nomi Health Commercial |
$220.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.37
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 00904707561
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: ASR Commercial |
$303.17
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$255.95
|
| Rate for Payer: BCN Commercial |
$242.32
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$312.55
|
| Rate for Payer: Healthscope Whirlpool |
$303.17
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Nomi Health Commercial |
$256.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.86
|
| Rate for Payer: Priority Health Narrow Network |
$219.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
VENLAFAXINE ER 37.5 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$294.50
|
|
|
Service Code
|
NDC 00904646861
|
| Hospital Charge Code |
27857
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.80 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Medicare |
$147.25
|
| Rate for Payer: ASR ASR |
$285.67
|
| Rate for Payer: ASR Commercial |
$285.67
|
| Rate for Payer: BCBS Complete |
$117.80
|
| Rate for Payer: BCBS Trust/PPO |
$241.17
|
| Rate for Payer: BCN Commercial |
$228.33
|
| Rate for Payer: Cash Price |
$235.60
|
| Rate for Payer: Cofinity Commercial |
$276.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.60
|
| Rate for Payer: Healthscope Commercial |
$294.50
|
| Rate for Payer: Healthscope Whirlpool |
$285.67
|
| Rate for Payer: Mclaren Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$241.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.04
|
| Rate for Payer: Priority Health Narrow Network |
$206.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$259.16
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.66 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: ASR ASR |
$287.51
|
| Rate for Payer: ASR Commercial |
$287.51
|
| Rate for Payer: BCBS Trust/PPO |
$241.54
|
| Rate for Payer: BCN Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$278.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$287.51
|
| Rate for Payer: Mclaren Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.83
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$226.57
|
|
|
Service Code
|
NDC 00093738598
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.63 |
| Max. Negotiated Rate |
$226.57 |
| Rate for Payer: Aetna Commercial |
$203.91
|
| Rate for Payer: Aetna Medicare |
$113.28
|
| Rate for Payer: ASR ASR |
$219.77
|
| Rate for Payer: ASR Commercial |
$219.77
|
| Rate for Payer: BCBS Complete |
$90.63
|
| Rate for Payer: BCBS Trust/PPO |
$185.54
|
| Rate for Payer: BCN Commercial |
$175.66
|
| Rate for Payer: Cash Price |
$181.26
|
| Rate for Payer: Cofinity Commercial |
$212.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.26
|
| Rate for Payer: Healthscope Commercial |
$226.57
|
| Rate for Payer: Healthscope Whirlpool |
$219.77
|
| Rate for Payer: Mclaren Commercial |
$203.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.58
|
| Rate for Payer: Nomi Health Commercial |
$185.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.52
|
| Rate for Payer: Priority Health Narrow Network |
$158.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.38
|
|
|
VENLAFAXINE ER 75 MG CAPSULE,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$296.40
|
|
|
Service Code
|
NDC 00904646961
|
| Hospital Charge Code |
27858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Medicare |
$148.20
|
| Rate for Payer: ASR ASR |
$287.51
|
| Rate for Payer: ASR Commercial |
$287.51
|
| Rate for Payer: BCBS Complete |
$118.56
|
| Rate for Payer: BCBS Trust/PPO |
$242.72
|
| Rate for Payer: BCN Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$278.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.12
|
| Rate for Payer: Healthscope Commercial |
$296.40
|
| Rate for Payer: Healthscope Whirlpool |
$287.51
|
| Rate for Payer: Mclaren Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.94
|
| Rate for Payer: Nomi Health Commercial |
$243.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.71
|
| Rate for Payer: Priority Health Narrow Network |
$207.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.83
|
|
